A CHOU 1,2, K LI 1,2, S FARSHID 2, A HOFFMAN 1, M BROWN 1,2
1St George Hospital, Kogarah, Australia, 2University of New South Wales, Kensington, Australia
Aims: To assess symptom burden and hospitalisation in elderly patients with advanced CKD managed without dialysis.
Background: The symptom burden of patients with advanced CKD is high escalates towards the end of life. Little is known regarding symptom trajectory in elderly patients on a CKM, non-dialysis pathway.
Methods: This prospective observational study on patients ≥65 years with CKD Stages IV and V was conducted at St George Hospital between March 2009-August 2018. Baseline demographic data and hospitalisation events were recorded, and symptom trajectory was assessed using the Integrated Palliative Outcome Score (IPOS)-Renal survey at each Renal Supportive Care (RSC) clinic visit for CKM patients or 6-monthly for dialysis patients.
Results: The most prevalent and severe symptoms reported by 250 CKM patients at baseline were lethargy (85%), poor mobility (76%), drowsiness (71%), pruritus (60%) and pain (56%). 59% of CKM patients had significant improvement in total symptom score by their 3rd visit to the RSC clinic (mean IPOS-Renal score 13.8, 95%CI 12.9-14.7 vs. 11.6, 95%CI 10.6-12.6; p<0.001). CKM patients reported a mean of 8 (SD±3.5) symptoms at baseline, 7 of which were described as severe by >50% of patients. CKM patients had an average of 8 admissions per year with median length of stay (LOS) of 8 days, compared with 19 unplanned admissions in the dialysis group with a median LOS of 35 days. The age-standardised hospitalisation rate was 8-fold higher among dialysis patients compared with CKM patients.
Conclusion: Elderly CKM patients managed through an integrated RSC clinic report an improvement in symptom burden by their 3rd visit. Rates of hospitalisation were lower in CKM compared with the dialysis cohort.
Dr Angela Chou completed a Renal Research Fellowship at St George Hospital and is currently a Renal Advanced Trainee in the East Coast Network. Her research on the Survival of Elderly Patients with Advanced CKD managed on a conservative (non-dialytic) pathway was presented at the American Society of Nephrology Kidney Week meeting in 2019. Her current research interest is in Renal Supportive care with a focus on the prognosis, symptom trajectory and quality of life of elderly patients with advanced CKD managed conservatively with the support of an integrated renal-palliative care program.